Millennium Development Goal: Motion.

Wednesday, 13 February 2008

Seanad Éireann Debate
Vol. 188 No. 11

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Senator Mark Daly: Information on Mark Daly Zoom on Mark Daly I move:

That Seanad Éireann acknowledging The Millennium Development Goal committing us to reducing maternal mortality by 75 percent between 1990 and 2015 in developing countries, supports the Government on its commitment to this goal and its substantial contribution to the new UNFPA trust which will be used to support 75 of the poorest countries deliver better services for women before, during and after childbirth.

I am honoured to be among the first to extend my congratulations to the Government on its commitment to promoting reproductive health in the developing world. The contribution Ireland has made to the No Woman Should Die Giving Life fund will promote real advances in the struggle against maternal mortality and disability.

Statistics are important but they are easy to hear, digest and forget. Some 500,000 annual deaths due to maternal mortality is a shocking number but ultimately, it is a number. What we need to remember is that these are mothers dying to bring children into the world. These are mothers who look forward to raising their children, providing for them and teaching them. However, the excitement and anticipation of pregnancy is mitigated by the very real possibility that childbirth will be accompanied by illness, disability or death.

These are real communities and they lose some of their most active contributors. They are families, not so different than our own, that lose a care-giver and a provider. They are children brought into a world without ever knowing their mothers. Babies are deprived of the maternal care which is so essential in that first year of life while children are deprived of the guidance and [811]the support of their mothers. We cannot expect to reduce child poverty on a large scale when millions of children grow up without the fundamental support that mothers provide.

Ireland is one of the first countries to donate to the No Woman Should Die Giving Life fund which was recently established by the UNFPA to stem the overwhelming numbers of mothers who die during pregnancy and childbirth. This contribution is a significant step towards eliminating the problem of maternal mortality and achieving the millennium development goals, which aim to end extreme poverty by 2015. However, this millennium development goal is one which the world is failing to meet.

We have made some significant progress towards achieving the goals set out by the United Nations at the beginning of the century. More children around the world are attending primary school, more women are participating in politics and certain health crises are beginning to be contained but maternal mortality continues to be an international crisis. The rate of maternal mortality in developing countries indicates not only inadequate health care services but also reflects a widespread violation of basic rights to life and health.

In Africa and south Asia, complications that arise during pregnancy are the most frequent cause of death among women. Unsurprisingly, the number of maternal deaths is highest in countries where the shortage of skilled health personnel is most acute. Exacerbating the problem in these countries is a severe lack of clean facilities and a dearth of adequate equipment. What facilities exist can be difficult to access for women who do not have a reliable means of transportation or an income above the poverty line.

Many women in developing countries report that a lack of cultural sensitivity, the unavailability of female health care providers and language barriers discourage them from receiving pre-natal care and prevent them from giving birth in hospital. Without the provision of culturally appropriate health care options, we cannot expect women to voluntarily seek care at hospitals, no matter how well medically supplied the facilities might be.

The Government’s recognition of these problems will go a long way towards getting more mothers access to appropriate health care facilities. The No Woman Should Die Giving Life fund is doing vital work to address the currently inadequate provision of health care for expectant mothers in the developing world. The UNFPA fund provides the support and tools for upgrading health care facilities and works toward ensuring universal access to information about reproductive health. This includes education on family planning and sexual health and making contraception more universally available.

The UNFPA fund maintains a special focus on ensuring the availability of pre and post-natal [812]counselling and care and on increasing the quality and availability of emergency obstetric care. Additionally, the UNFPA is committed to advocating maternal health reforms and women’s rights on both national and international levels. The UNFPA actively seeks the aid and input of local community and religious leaders who best understand the cultural needs of their communities.

The Government has also made generous contributions to funds that target the problems of obstetric fistula and female genital cutting. Obstetric fistula, caused by prolonged and complicated labour without treatment, is a leading cause of death for infants and disability for mothers. Given the stigma associated with fistula, a woman disabled by fistula will often descend into social isolation, depression and deepening poverty.

Fistula is entirely preventable but only with timely access to emergency obstetric facilities. Obstetric fistula throws the differences in maternal care between the developed and the developing worlds into sharp focus. While fistula affects an estimated 2 million women in developing countries, it is virtually non-existent in Europe and North America. One estimate suggests that in Ethiopia, it takes a woman an average of 2.5 days to reach an operating room to address a complicated pregnancy. By the time she gets there, it is usually too late to save the infant and the mother will be disabled for life.

The Government’s contribution of €500,000 to the UNFPA Campaign to End Fistula will aid the provision of skilled attendants at births in 35 countries where fistula is particularly prominent. The fund also provides treatment and assists reintegration for women who already suffer from fistula. The UNFPA is working to increase awareness of the gravity of fistula both at a community-level and among policy makers. Obstetric fistula is a condition that no woman should live with. I commend the Government’s vision in targeting this serious cause of maternal disability.

The Government has also made a contribution to a fund targeting the practice of female genital cutting. Genital cutting affects about 130 million girls and women worldwide and 2 million more are at risk every year. This procedure threatens sexual and reproductive health as well as psychological well-being. The UNFPA programme works with young people and religious and community leaders on a local level to establish approaches to eliminating the practice that are sensitive to the cultural dignity of the community. These programmes have seen success in several developing regions and with the Government’s contribution to the fund, the programmes can be extended across much of sub-Saharan Africa. Again, I applaud the Government’s efforts to help eliminate a practice fundamentally contrary to basic human dignity.

Maternal mortality and disability have a devastating effect on families and communities. More [813]than half a million mothers die annually from complications that arise during pregnancy and childbirth. More than 10 million others are left with severe illness or disability following delivery. The vital contribution women make as mothers, carers, members of the workforce and active community members cannot be replaced when lives are lost or mothers are seriously disabled during childbirth. Maternal mortality leaves more than 1 million children motherless each year, and children who have lost their mothers are up to ten times more likely to die prematurely.

We are capable of drastically reducing the occurrence of death during pregnancy and childbirth. The real tragedy of maternal mortality is that it is so highly preventable. Investments in training for health care providers and the upgrading of health care facilities have already significantly reduced the number of mothers dying during childbirth in Latin America, south-east Asia and the Middle East. Progress in these regions is laudable, but the situation is still dire in many parts of the world. Given that it is so preventable, maternal mortality is unacceptable anywhere. The Government’s contribution to the No Woman Should Die Giving Life fund is a significant step toward ending the unnecessary deaths of mothers.

As Ireland grows increasingly cosmopolitan, our world view has also broadened. Our economic success has created the opportunity to look beyond our own borders and become active citizens of the world. The steps we are taking to eliminate the problem of maternal mortality underline our commitment to the world’s poor.

I congratulate the Government again on its international leadership in working to save the lives of hundreds of thousands of mothers and children. This important contribution has brought us one step closer to realising the ideals that the millennium development goals set eight years ago, and the impact made in the lives of millions of mothers and families will reverberate across the developing world. I commend the motion to the House.

Senator Ann Ormonde: Information on Ann Ormonde Zoom on Ann Ormonde I second the motion that Seanad Éireann acknowledges the millennium development goals and that we are committed to reducing the maternal mortality by 75% between 1990 and 2015 in developing countries. I also acknowledge the commitment of the Government and its substantial contribution to the new UN population fund agency, and that we will support 75 of the poorest countries to deliver better services for women before, during and after birth. I agree with all those aspects of the motion. I welcome the Minister of State to the House and I acknowledge his announcement that he has now provided over €3 million in funding to programmes targeting maternal mortality and reproductive health in developing countries. Let there be no doubt that the Government’s intention is sincere.

[814]I acknowledge there was a lack of response to the millennium development goals and perhaps we should have pushed a little harder. Nevertheless, the sincerity is there and we will reduce maternal mortality. The least amount of progress was in the area of maternal mortality. At present, the number of women dying in child birth is huge. The risk of dying is great among those giving birth, with 500,000 dying last year. It is horrific to read that and the Minister of State is very much aware of it. As a nation, we must do everything in our power to see how we can make sure those numbers will decrease annually.

We are the first country to contribute to the UN population fund agency. I love its beautiful line, “No Woman Should Die Giving Life”. We must keep that in our thinking all the time, because if every country adopts that line in its commitment to reducing maternity mortality, then the sincerity will be reinforced. This fund is providing funding to 75 countries to help women before, during and after birth. The agency is promoting the right of every man, woman and child to enjoy a life of health and equal opportunity. It is trying to reduce poverty, to ensure that pregnancy is safe and wanted, that every young person is free from AIDS and is treated with dignity and respect. That is the value of this agency.

I did not know anything about the agency until it became part of my brief to understand the nature of overseas aid and to see how I could contribute to make sure that Ireland’s contribution will be to the forefront. I compliment the agency for making sure that its concepts are endorsed. Ireland is a strong supporter of this agency and it contributed over €4.5 million to the organisation in 2007. Ireland also contributes over €1 million for reproductive health issues such as contraceptives and basic obstetric supplies. These are areas that we should be promoting and we should be making sure that all the facilities are available for pregnant women. I wonder if €500,000 is enough, or whether back-up supports are available to help young women in these situations. We need to reduce the number of those who die at child birth for the simple reason that they do not have the facilities, the supports or the supplies available. I question the Minister of State on that sum. We are talking about 500,000 women who die every year at child birth.

I am also aware that €500,000 is provided to stop female genital cutting, a phrase which sounds awful. How can we reach out to these young people when over 3 million girls are at risk of this practice annually? I would like to shout the question from the rooftops as to how we can stop it. Is there any way to break through this religious and cultural way of life in some of these communities? We must do it. I want to be a leader in this, if I can. These young people are vulnerable, and include baby girls only one or two years old. They come to Ireland as asylum seekers on the basis that if they are sent back to their own countries, they will be subjected to these practices.

[815]My heart is in the right place when I talk about this issue. The Minister must do everything he can to promote these changes. It can be done through public relations exercises, through our services, our NGOs and our missionaries. The infrastructure is in place and we must move to make sure that this is no longer a part of our thinking. We should not be talking about issues like this in ten years’ time.

I welcome the goals we have set for the next ten years. The policy in this respect is to reduce maternal mortality and ensure reproductive health. We, as a nation, should do that in any way we can. We should shout from the rooftops to protect young and older women from atrocities carried out in sub-Saharan states.

Senator Maurice Cummins: Information on Maurice Cummins Zoom on Maurice Cummins I wish to share my time with Senator Fitzgerald.

An Cathaoirleach: Information on Pat Moylan Zoom on Pat Moylan That is agreed.

Senator Maurice Cummins: Information on Maurice Cummins Zoom on Maurice Cummins I do not intend to move the amendment to the motion. We reached agreement on the motion, which was changed. Therefore, we are pleased to withdraw our amendment as a result of that change. It is important there is unanimity on this type of issue.

At the UN in 2000 the Taoiseach pledged that Ireland would reach the target of 0.7% of GNP in development aid by 2007. That pledge fell by the wayside. However, we acknowledge that if the trend of the past two years continues, we should reach the target by 2012. Based on last year’s budget it is expected that €914 million in overseas development aid will be provided this year, which is a significant sum. It is imperative that this taxpayers’ money is used wisely and accounted for fully.

Fine Gael strongly supports the millennium development goals laid out by the United Nations in 2000. Their principles, eradicating extreme hunger and poverty, achieving universal primary education, gender equality, reducing child mortality, improving maternal health, combating HIV-AIDS, malaria and other diseases, ensuring environmental sustainability and ensuring a global partnership for development are all worthy and necessary.

The motion before us refers to the fifth millennium goal, improving maternal health. The target is to reduce by three quarters between 1990 and 2015 the maternal mortality ratio. According to the UN Millennium Development Goals Report 2006, the rates of maternal mortality appear to have changed little since 1990. The worst affected regions are sub-Saharan Africa and southern Asia. To understand the scale of the problem, I recommend that Members check a website, mdgmonitor,where one simple map illustrates the severity of the problem.

The United Nations Family Planning Association’s role is largely concerned with, as its name [816]suggests, family planning and avoiding unwanted pregnancies, safe child birth, avoiding sexually transmitted diseases, combating violence against women, stopping the horrendous practice of female circumcision and promoting gender equality. Ireland, as well as the EU, has a history of supporting the UNFPA in its work to ensure fewer deaths as a result of pregnancy.

The George W. Bush Administration claimed that the UNFPA is involved in the promotion of abortion. This has been disproved by a number of independent researchers. I received a document from the Pro-Life Campaign yesterday, as I am sure did others Senators, a group which also questions the funding of the UNFPA. Perhaps the Minister of State might wish to clarify and comment on this matter.

The maternal mortality ratio has been declining at a rate of less than 1%. In 2005 536,000 women died of maternal causes compared with 576,000 in 1990. In sub-Saharan Africa a women’s risk of dying from such complications in the course of her lifetime is one in 16, compared to one in 3,800 in the developed world. This is a damning statistic.

Though the causes of maternal deaths are varied, the majority of such deaths and disabilities could be prevented through appropriate reproductive health services before, during and after pregnancy and through life-saving interventions should complications arise. Attendance at delivery by skilled health personnel is critical in this respect, as such personnel are trained to detect problems early and can effectively provide or refer women to emergency obstetric care when needed.

One of the major problems in targeting this development goal is the lack of appropriate data both for earlier years and more recently. The statistic annex of the UN Millennium Development Goals Report 2007 does not have adequate data for 1990 to provide a base level for maternal mortality, nor for any year since 2000. A single piece of data in 2000, namely, the number of maternal deaths per 100,000 live births, reveals a stark contrast between the developed world and certain developing regions in the world, particularly sub-Saharan Africa. The number of births attended by skilled health personnel shows that while some regions have made substantial progress in this area, for example, north Africa, Latin America and the Caribbean, others have fallen back slightly or remain in very low terms.

I welcome the fact that Irish Aid assisted two projects relating specifically to maternal mortality in 2006. It assisted an obstetric care maternal mortality project in Sierra Leone and a body in Nicaragua to build 14 mother and child care hostels, which also received a significant grant.

The €3 million funding which the Minister of State announced is to be welcomed. We, on this side of the House, certainly welcome it.

[817]Senator Frances Fitzgerald: Information on Frances Fitzgerald Zoom on Frances Fitzgerald I thank Senator Cummins for sharing time with me.

I welcome this opportunity to make some brief comments on this debate. The Irish Family Planning Association is a collaborating non-governmental organisation with the UNFPA and, as such, has assisted in the work of the all-party committee on sexual and reproductive rights, founded in 2000 by Mary Banotti, a former MEP and the former Senator, Mary Henry. I congratulate them on the work they have been doing since then.

In the short time available to me I want to outline a few facts on the experience of adolescent girls in developing countries and to ask the Minister of State to pay particular attention to this issue and perhaps discuss with Irish Aid how it can invest more strategically in the health education and livelihoods of adolescent girls to empower them to avoid the trap of becoming mothers while still children. This is a major issue in many developing countries. We need to ensure more programmes are put in place to target young first time mothers and to reach out to those young women in need of health services, including sexual and reproductive health services.

Pregnancy and childbirth related death is the number one killer of 15 to 19 year old girls worldwide. Each year nearly 70,000 teenage girls die and at least 2 million more are left with debilitating or chronic illnesses that can bring them lifelong suffering. It is estimated that every year 14 million adolescent girls between the ages 15 and 19 give birth and many other younger girls give birth who do not even feature in the records. High rates of adolescent pregnancy persist in many countries, even though the rate is declining worldwide. These are countries where poverty and poor health are endemic. On average, one third of young women in developing countries give birth before the age of 20. This puts these young women at huge risk. I ask that we focus on this group of young women in the aid we give and develop more strategic programmes to reach them in the countries to which we give aid. This is most prevalent in sub-Saharan Africa where more than 50% of adolescent girls give birth by the age of 20. In some sub-Saharan countries the figure is more than 70%. This happens particularly in countries where child marriage rates are high, including much of west, central and east Africa, and south Asia. It is an area on which we need to focus and if we do, we will substantially improve the lives of these young women.

Senator Déirdre de Búrca: Information on Déirdre de Búrca Zoom on Déirdre de Búrca I also welcome this opportunity to recognise the important contribution that Ireland is now making towards achieving the millennium development goals, in particular goal No. 5, which has been referred to by other speakers, to improve maternal health and specifically to reduce by three quarters the maternal mortality rate in developing countries. Under this commitment the aim is to reduce [818]maternal mortality by 75% over a period of 25 years. This is a significant and ambitious target, but it is entirely achievable. It is clear from this debate that so many of these deaths are avoidable. They are deaths which would not occur if the mothers were living in the developed world and are due to the lack of antenatal services which is the cause of a great number of the complications that arise around childbirth.

  6 o’clock

Some 75 of the poorest countries will be targeted by the millennium development goal and Ireland has made a substantial financial contribution both to the UNFBA fund of €2 million and also the trust fund on female genital mutilation, operated jointly by UNICEF and UNFBA. Currently, female genital mutilation or cutting affects between 100 million and 140 million women and girls — and 3 million girls are at risk of the practice annually. The programme is designed to work with cultural and religious leaders to encourage a societal change and the abandonment of the practice. That more constructive approach is to be encouraged as sometimes we may express cultural disapproval of practices in the developing world without understanding the long traditions and roots in particular communities. A process of education and encouragement is a more productive approach. Funding of €500,000 will be provided for that along with another €500,000 from the Government to the fistula schematic trust fund.

Again, this was established as part of the UNFBA’s campaign to end fistula. Obstetric fistula is typically the result of prolonged and obstructed labour, most usually when medical intervention or Caesarean section is not available. The pressure of the baby’s head against the mother’s pelvis causes extensive tissue damage, making her incontinent, and in most cases the baby does not survive. This programme aims to prevent the condition by ensuring skilled attendance at births and to provide treatment from those who have suffered from fistula.

It is very important that the half a million who die every year in sub-Saharan Africa and southern Asia from treatable and preventable complications of pregnancy and childbirth will now be supported, and hopefully other EU member states will also contribute to these funds. Ireland has been one of the first to do so. When expected outcomes for mothers in sub-Saharan Africa are compared to the prognosis for women giving birth in developed countries, the risk of a mother dying in the former region from childbirth related complications over the course of her lifetime is one in 16 as compared to one in 3,800. Those differentials are unacceptable. I am not a mother, but any woman in the developed world who is, must have an instant sense of concern and responsibility for women who find themselves in those situations in less developed parts of the world, and who face much poorer outcomes.

[819]What can be done in terms of trying to address this very ambitious target of a reduction of 75% in maternal deaths? Other speakers have referred to the importance of introducing appropriate reproductive health services, before, during and after pregnancy and also through life-saving interventions if complications arise. This involves attendance at deliveries by skilled health personnel, doctors, nurses and midwives, who are trained to detect problems early and can effectively provide or refer women to obstetric care when needed. The regions with the lowest proportions of skilled health attendance at birth are sub-Saharan Africa and southern Asia but unfortunately, they also have the highest numbers in term of maternal deaths. Disparities in the supports available to women during pregnancy and childbirth are also evident both among countries and within them.

According to surveys carried out between 1996 and 2005 in 57 developing countries, 81% of urban women deliver with the help of a skilled attendant, as against only 49% of their rural counterparts. The difference the increased supports that are available to urban women make stand out in comparison to their rural counterparts. Hopefully the UNFBA programme will focus to a large extent on the rural women who seem to have much poorer outcomes.

Some 84% of women who have completed secondary or higher education are attended by skilled personnel during childbirth. That is more than twice the rate of mothers with no formal education. While educational level plays an important part in outcomes, such as in childbirth, this will have to be taken into consideration. Antenatal care has long been recognised as a core component of maternal health services and can serve as an important entry point into the wider health care system for women who, perhaps, do not avail of important and critical health services. Since 1990, every region in the developed world has made progress in ensuring that prospective mothers receive antenatal care at least once during pregnancy. Even in sub-Saharan Africa where the least progress has occurred, more than two-thirds of women receive antenatal care at least once during pregnancy. This is stated in the UN’s millennium development goal report in 2007. That same report states that for antenatal care to be effective, international experts recommend as essential at least four visits to a trained health care practitioner during pregnancy. Another point made very clearly in this report is that no single intervention can address the multiple causes of maternal deaths, and that efforts to reduce maternal mortality need to be tailored to local conditions, since the cause of maternal deaths can vary across developing regions and countries in Africa and Asia.

In Africa and Asia haemorrhage is the leading cause of maternal deaths while in Latin America and the Caribbean, hypertensive disorders during [820]pregnancy and childbirth pose the greatest threat. Obstructed labour and abortion account for 13% and 12%, respectively, of maternal mortality rates in Latin America and the Caribbean and in Asia, while anaemia is a major contributor to maternal deaths, but is a less important cause in Africa and a negligible factor in Latin America.

It is important that whatever programmes are developed are very much tailored to local needs. The last issue to which I wish to refer — the report touches on it — is that of preventing unplanned pregnancy and the need to make contraceptive services and contraception more freely available to young women, particularly in developing countries. It is estimated that at present, 137 million have an unmet need for family planning in the developing world. An additional 64 million women are using traditional methods of contraception with high failure rates. Contraceptive prevalence has increased slowly, from 55% in 1990 to 64% in 2005, but it remains very low in sub-Saharan Africa, at 21%. These are all issues that need to be tackled, but I commend the Government on the important financial support it has given towards achieving the millennium development goal of reducing maternal deaths. I look forward to a further opportunity to address this topic, perhaps in a year’s time, when we can review the issue again and see what type of progress has been made.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen I welcome the Minister of State to the House. The idea of the Irish Government spending money for these declared purposes is laudable. The millennium development goals commit us to reducing maternal mortality by 75% between 1990 and 2015. Any money we spend seeking to prevent female genital mutilation and maternal mortality and on the campaign to end fistula is money well spent. I commend the Government on its right intention in contributing generously to these purposes.

What is less clear, however, is whether the UNFPA is the organisation that should receive this funding. I acknowledge that the Minister of State has inherited a situation here. He is not long in the brief. As Senator Cummins mentioned, concerns have been expressed about whether the UNFPA is the correct organisation to be trusted with funds for these very sensitive purposes. Its activities in regard to the promotion of abortion in different parts of the world have been documented. I wonder whether Senator Cummins was asking if that had been disproved or merely disputed. The voices that have expressed concern about the UNFPA’s activities are very respectable. I understand they are the right aims but I put the Minister of State on notice that I will be visiting him in his Dublin office and in his home constituency to talk about whether the UNFPA should be in receipt of Irish funding without guarantees that we have not had to date.

Let me say a little more about what I mean. I shall start by talking about two cases. Magna [821]Morales was a Peruvian woman. Government officials in that country, as part of its controversial policy of population control, took her from her village in Northern Peru and subjected her to tubal ligation. Essentially, it entailed the tying up of her fallopian tubes in order to stop her having any more children killed her. The mother of five children died ten days after the operation due to the lack of follow-up medical care.

On the other side of the world, in Sihui county in China, women are routinely forced to have abortions and sterilisations under that country’s horrific one-child policy. Women who have had more than one child, or two in rural areas, are subject to fines, and can have their houses destroyed if they attempt to flee. This policy, which is almost 30 years old, was intended to curb population growth in that country. It has certainly achieved that but at a huge cost, as in Peru, to women’s rights and human dignity generally. These barbaric practices may seem to belong to a more brutal era but they are happening now and we in Ireland may well bear some responsibility for them.

As we debate this motion congratulating the Government for giving an extra €3 million for these purposes, most of it to the United Nations Fund for Population Activities, we have to ask about the UNFPA’s performance to date. This is an organisation that received €4.5 million in core funding last year in addition to funding of TRUS. It is assumed, therefore, that they will receive between €5 million and €8 million this year. The UNFPA insist, as do its many defenders, that it does not promote or support coercive population policies. It points to its statutes which forbid the funding of abortion, involuntary sterilisation or coercive practices of any kind. It limits its reproductive health promotion to the provision of contraception, or so we are told. For over a decade, evidence has been building up to show that it is intimately involved in promoting abortion, in terms of providing equipment and pressurising countries whose laws forbid abortion to legalise the practice. It is no consolation to me that Senator Fitzgerald mentioned that the enforcing agency — I think she used the interesting term the “collaborating agency”— in Ireland of the UNFPA is the Irish Family Planning Association because it does not have a good record when it comes to honouring the constitutional values of the dignity of all persons born and unborn.

In 1998, an investigation by the US Congress found that UNFPA activity in China amounted to effective support for China’s notorious forced abortion and sterilisation policies. Evidence was recorded of forced sterilisation, forced abortions and extra judicial detentions for those who did not comply with the Chinese government’s policy. All this was happening while the UNFPA was aiding the Chinese population programme and denying there was any coercion. In 2001, a further hearing determined that coercion was still a key [822]part of Chinese policy. People who like to close their eyes to these facts like to claim that the people who make these claims are right wingers.

Congressman Chris Smith in the United Stated is no right winger. He is a champion of various human rights causes, from the rights of immigrants to the rights of people with autism to the prevention of torture. In fact he should run for the presidency of the United States some time. He would make a refreshing change from those who seem to advocate torture as a necessary part of keeping their country safe. He says that the UNFPA has worked hand in glove with China’s repressive population policy. He points to the fact that the UNFPA has repeatedly defended the Chinese one-child policy, even praising it on some occasions. In 1981, the then executive director of the organisation, Rafael Salas called the one-child policy “a superb example of integrating population programs with the goals of national development”. In 1983, the UNFPA established a new honour called the United Nations Population Award, a sort of Nobel Prize for population control programmes. One of its inaugural recipients was the Chinese state family planning commission, which was responsible for all I have outlined.

In 1998, UNFPA changed tack, condemning the coercion so crucial to Chinese policy. However, it still maintained its close ties with the Chinese regime. According to UNFPA and its allies, UNFPA only resumed operations in China after Chinese officials agreed to end all quotas and birth restrictions. Former US Secretary of State, Colin Powell, no right winger, declared in 2002——

Senator David Norris: Information on David P.B. Norris Zoom on David P.B. Norris A left winger.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen Senator Norris will have his chance in a short time. He declared in 2002, on the basis of a state department investigation, that the US was suspending its funding of the UNFPA because of its involvement in the Chinese one-child policy. He specifically referred to the UNFPA’s assistance in administering the “social compensation fees” which the Chinese Government impose on women who have more than the regulation number of children. Where are the activists for women’s rights now? This penalty can be up to three years worth of income, which is a crushing amount.

If the House is still not happy with the examples I have given, consider the Peruvian situation where its leader, Alberto Fujimori, ran that country like a personal fiefdom for nearly a decade before he was turfed out in elections in 2000. What emerged after his departure from office was a series of sandals, the most serious of which involved the forcible sterilisation of women in poor rural villages. Government officials, who were given monetary rewards for each woman sterilised, used carrot and stick techniques to cajole, trick or force them. When the Peruvian [823]parliamentary commission examined the issue it discovered that the UNFPA was central to these activities, together with the US foreign aid agency, USAID.

We need to address issues of maternal mortality as a fundamental issue in the promotion of human dignity. We have to look hard again at whether UNFPA as an organisation can be trusted to honour our constitutional values which are about showing love and care to women and men, born and unborn. We need to give the money but, perhaps, we need to consider giving it to non-government organisations which can be trusted, such as Mater Care, an organisation which seeks to assist women and children in pregnancy.

An Cathaoirleach: Information on Pat Moylan Zoom on Pat Moylan The Senator’s time is up.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen I thank the Minister of State for coming to the House and wish him well in his duties. I ask him to look again at those with whom he is co-operating in the pursuit of what are undeniably laudable aims but some Irish money may end up enforcing consequences that are very much less than laudable.

Senator Fiona O’Malley: Information on Fiona O'Malley Zoom on Fiona O'Malley I welcome the Minister of State to the House. I am glad to speak after Senator Mullen because it is important that there is a proper debate about the finances of the UNFPA. I congratulate the Minister of the State on the work he has done and in providing increased funding to the UNFPA. I think Senator Mullen slightly lost sight of the millennium development goals and the plight of women and children, particularly in the developing world, but not exclusively. I looked at the Senator as he was speaking and I thought to myself that he was a very fortunate man. He is a fortunate man because he is not a woman.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen I am regarded as a devil’s advocate most of the time.

Senator Liam Twomey: Information on Liam Twomey Zoom on Liam Twomey He might be quite happy as a woman.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen I would receive an ovation from all the political parties if I were a different gender.

An Cathaoirleach: Information on Pat Moylan Zoom on Pat Moylan Senator O’Malley, please.

Senator Fiona O’Malley: Information on Fiona O'Malley Zoom on Fiona O'Malley It is an issue the Senator will never face. This is what depresses me. I do not mean to be disrespectful because the Senator’s opinions are genuinely held and I respect him for them but I disagree with him.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen There are unborn women as well.

[824]Senator Fiona O’Malley: Information on Fiona O'Malley Zoom on Fiona O'Malley We need to focus on the good work done by the UNFPA. Many people will — we are all guilty of this — promote the aspects of an organisation that concur with our own beliefs. Time and again, however, highly-regarded institutions such as the WHO and the UN have refuted the allegations being made. Senator Mullen chose his words carefully, saying “or so we are told” and replying to Senator Cummins by asking whether information was “disproved or merely disputed”. I disagree and suggest the arguments have been well refuted at this stage. Senator Mullen cites the few examples that cause difficulties but this is proof because the same ones keep happening again.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen No matter how egregious.

Senator Fiona O’Malley: Information on Fiona O'Malley Zoom on Fiona O'Malley What depresses me about the arguments one hears and the documentation one receives in this regard is that they do not move on. They are in a time warp.

Senator Alex White: Information on Alex White Zoom on Alex White Hear, hear.

Senator Fiona O’Malley: Information on Fiona O'Malley Zoom on Fiona O'Malley The response is the same as it has been since I became a public representative. It is a case of send out the e-mail and forget about the changes in facts and the new studies and results. It is a case of, “We believe the UNFPA is assisting with maternal health and we do not agree with it, so let us keep this show on the road.”

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen I do not disagree with that.

Senator Fiona O’Malley: Information on Fiona O'Malley Zoom on Fiona O'Malley A particularly laudable aspect of this development goal is that maternal mortality is largely preventable and is one of the millennium development goals on which we can really make progress. I applaud Ireland’s increased assistance to and support of the UNFPA, as I applaud the new initiatives on the part of the Government in regard to gender-based violence and the targeting of funding against female genital mutilation, which is highly important. Given that maternal mortality is largely preventable, it is a problem the international community should galvanise itself to eradicate — Ireland is doing a good job in this area.

Pregnancy is the number one world killer of adolescent girls. That should not be the case. We know from our own experience the extent of maternal mortality and related problems. Contraception was part of dealing with that problem. People, particularly women because they carry the burden of the pregnancy, are entitled to the choice. Turning a blind eye to the function or role of contraception in dealing with the millennium development goals and population issues is utterly foolish. We need only look at our own his[825]tory. Women died while giving birth to their 16th child. It is inhumane to subject a person to this. Just because we have advanced, it is not acceptable that we deny that option to poorer people.

Another issue with regard to the millennium development goals is the unmet need for family planning. The Minister of State will know I am chair of the all-party group on sexual and reproductive health. We offer an invitation to the Minister of State to meet us, and hope he will do so. It is a cross-party group which welcomes all shades of opinion.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen Is the Senator sure?

Senator Fiona O’Malley: Information on Fiona O'Malley Zoom on Fiona O'Malley We do so because a good debate is needed. We would welcome the Minister of State.

One aspect of the work of the all-party group on which it would be good to have all-party agreement — I think we will achieve it — is legislation to outlaw the practice of female genital mutilation.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen Hear, hear.

Senator Fiona O’Malley: Information on Fiona O'Malley Zoom on Fiona O'Malley It is important we achieve that.

It is through international travel that one gets to know more about these issues and this is an issue of which I am aware through the work of the all-party group. I support the work of the Irish Family Planning Association in this country and abroad. It is our duty as parliamentarians to see what is going on in the world. It is our duty to the Irish people that we know what the UNFPA is doing with Irish money. This is why I welcome visits on the part of the Oireachtas Joint Committee on Foreign Affairs or the all-party group on sexual and reproductive health, which has a good reputation for the work it has done, including, as noted by Senator Frances Fitzgerald, the great work done by its former chairperson, former Senator Mary Henry.

The Minister of State should not be deflated by groups who might seek to stop funding of a laudable issue. I wish him well in his continued efforts to achieve the success of the millennium development goals.

Senator Alex White: Information on Alex White Zoom on Alex White I welcome the amendment agreed by Fine Gael colleagues in respect of the motion put down by the Fianna Fáil Members, which is the right way to proceed. On a point I have raised before in Private Members’ debates, there is a limit to the extent to which we should politicise such issues. There is no doubt that when Government Members seek to congratulate the Government, irrespective of the proposal, this immediately sets off a certain reaction among the Opposition. Perhaps this is wrong and perhaps we are too quick to respond in this way. Unfortunately, however, it is a two-way process and it tends to happen the other way around.

[826]I welcome the more or less non-partisan approach to all of the issues encompassed in this proposal.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen We are all non-partisan.

Senator Alex White: Information on Alex White Zoom on Alex White I found myself unusually but happily in complete agreement with what Senator O’Malley had to say. I do not understand the rush to attack the UNFPA to which Senator Mullen seems to have succumbed. I understand and respect the views he holds, and he has articulated them very well in this House, but the notion that the UNFPA or other UN organisations cannot be trusted because they engage in vital work in this sector seems odd. I question whether Senator Mullen’s criticism of or attack on the UNFPA is in a sense a cloak for some other points he wants to make in this respect.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen No, it is not. It is a question of how it uses its budget.

An Cathaoirleach: Information on Pat Moylan Zoom on Pat Moylan Senator White, without interruption, please.

Senator Alex White: Information on Alex White Zoom on Alex White The kind of work for which the UNFPA is using its budget, and which appears to concern Senator Mullen, has to do with, for example, being part of ensuring a significant decline in maternal mortality in countries such as China, Cuba, Egypt, Jamaica, Malaysia, Sri Lanka, Thailand and Tunisia as more women have gained access to family planning and skilled attendance at birth, with backup emergency obstetric care. This is the kind of initiative in which the UNFPA is engaged and is not one in respect of which I have any concern.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen That is the good side.

Senator Alex White: Information on Alex White Zoom on Alex White I cannot understand how anybody could for a moment have a difficulty with such an organisation. The UNFPA is engaged in vital work to ensure we reverse the situation in our great, rich world whereby the risk of a woman dying as a result of pregnancy or childbirth during her lifetime is approximately one in seven in Afghanistan and Sierra Leone compared with approximately one in 30,000 in Sweden, which presumably is the country Senator Mullen would have difficulties with in regard to its family planning regime.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen The Senator is misrepresenting my position, which is not surprising.

Senator Alex White: Information on Alex White Zoom on Alex White Senator Mullen did not mention contraception during his contribution. He used the phrase “coerced” at least 15 times but the notion that availing of family planning or legal, safe abortion is in all circumstances a coercive act or that a woman must be coerced in cir[827]cumstances where she chooses to have an abortion is bogus. It is not in all circumstances——

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen The Senator should examine what is happening in China.

An Cathaoirleach: Information on Pat Moylan Zoom on Pat Moylan Senator Mullen cannot continue to interrupt. Senator Alex White has the floor and should not be interrupted.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen Senator White keeps misrepresenting me.

An Cathaoirleach: Information on Pat Moylan Zoom on Pat Moylan Senator Mullen made his contribution and Senator Alex White has the floor to make his contribution now.

Senator Alex White: Information on Alex White Zoom on Alex White I recall a conversation with Senator Mullen before we both entered the House when he said the debates he looked forward to having with me and others would be calm, reflective and discursive but I cannot get through a sentence without being interrupted.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen Because the Senator keeps referring to me in the wrong.

Senator Alex White: Information on Alex White Zoom on Alex White It is because Senator Mullen does not agree with what I am saying.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen I agree with some of the Senator’s comments.

Senator Alex White: Information on Alex White Zoom on Alex White An estimated 200 million women in the world, despite what the Catholic Church and others say, wish to delay or avoid pregnancies without availing of family planning. I cannot understand why a policy would be in place anywhere to deny women access to family planning. I ask all Members and not only Senator Mullen why we would deny family planning to women.

It is correct that the UNFPA and other organisations should promote family planning in every country and not, as Senator O’Malley said, only in rich countries where people can afford it. Demand for contraception is increasing not only in the coercive sense where people are told to use contraception to limit their families but because they make a free decision to do so. That does not have to flow from the coercion of women. One in three deaths relating to pregnancy and childbirth could be avoided if women who wanted effective childbirth had access to family planning. An estimated 19 million unsafe abortions are carried out each year in developing countries. What will be done about that? Is it not correct that an organisation such as the UNFPA should have a role in addressing such issues? If internationally funded organisations are charged with addressing these issues, I have no difficulty with them dealing with these “sensitive questions of contraception and abortion”, as Senator Mullen called them.

[828]Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen And unconstitutional.

Senator Alex White: Information on Alex White Zoom on Alex White Last week we debated what the Constitution means in the context of abortion and Senator Mullen probably disagrees with the Supreme Court in that regard.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen I agree we have a law.

An Cathaoirleach: Information on Pat Moylan Zoom on Pat Moylan The Senator has one minute remaining.

Senator Alex White: Information on Alex White Zoom on Alex White How many minutes were taken by my friend?

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen The Senator’s references to me added up to a few minutes.

Senator Alex White: Information on Alex White Zoom on Alex White Every year 90% of abortion related deaths and disabilities could be avoided if women had access to effective contraception. I have no concerns about the Government’s position. I congratulate the Government on what it has done. It is vital it continues to make the contribution at international level that it has. Ireland should have no concerns, such as those expressed by earlier speakers, in respect of the UNFPA. The agency is doing magnificent work and we ought to support it.

Senator Liam Twomey: Information on Liam Twomey Zoom on Liam Twomey Whatever about Senator Alex White congratulating the Government, when the Government congratulates itself, it smacks of a self-delusional, almost patronising and colonial attitude. It is not long since Ireland declared itself a republic and the Government should not engage in such behaviour but when parties are in Government too long, these habits creep in. The debate gives a sense of us all trying to keep ourselves happy and we are deluding ourselves regarding the protection of the environment and carbon credits and so on. The sum of €4.5 million for this development goal will not make a significant impact. This is our contribution while our overseas development aid budget is in excess of €900 million. I expected the debate to focus on the broader issue.

The diverging views that have emerged during the debate are interesting and no one’s contribution should be dismissed whether reference was made to family planning or the misappropriation of UN funds. These issues should be investigated and evaluated further. If on behalf of the people the Government will spend almost €1 billion annually on ODA in years to come, it must be sure such abuse is not taking place. The recent focus on ODA has highlighted the issue of aid finding its way to corrupt officials in certain countries. They are being handed cheques to spend as they wish. It does not matter whether this relates to a corrupt African nation or a UN body which is accused of being very bureaucratic and top-heavy in administration.

The lifestyles of many of those who work for the development agencies is very good. We [829]assume countries such as South Africa, Kenya and Mozambique are poverty stricken but that is not the case. One can have a good time living in these countries. Many of those working for development organisations have fine houses and swimming pools and it is important the issue of these organisations spending their allocations appropriately on the basis of the expectation of the Irish taxpayer or administratively should be debated. The taxpayer, for example, would not approve of coercion into forced sterilisation. Rather than shouting down Senator Mullen for raising this issue, it should be investigated further by the Government to ensure it is not taking place.

The issues raised regarding maternal death are incredibly important, including the medical facilities available in these countries and the lack of nurses and doctors. This lack is due to First World countries poaching them to work in their own hospitals and other health care facilities because they do not spend enough money to train enough personnel of their own. When one visits any hospital in Dublin, one will meet doctors and nurses from Nigeria, Mozambique, Sudan, Chad, the Philippines, Bangladesh and Pakistan. If they are here, they are not looking after their own people. A sum of €4.5 million is poor compensation for those countries considering we are stealing their health care workers. The Government must face up to this and stop clapping itself on the back because it is contributing to many of the problems experienced by Third World countries.

Much of our overseas aid is spent on armaments to support undemocratic regimes. The way these regimes spend this aid and abuse their own citizens by burning or shooting them or turning them into refugees results in a huge cost to those countries. We must face up to our responsibilities and discuss these issues during debates such as this. We could put forward proposals but we should not shout down any Member who raises an issue that might not necessarily fit with our ideology. Our best approach is to seek value for money for the ODA budget of €1 billion, examine where it is being spent and take the radical actions mentioned. This would include denying funding to regimes that might be stealing the aid and exercising the same quality control over this budget as would be exercised over departmental budgets to ensure the money is spent on the mothers and children who need this health care. We are discussing maternal deaths but neonatal and early childhood death rates are also significant in these countries.

Millennium development goal No. 6 concerns HIV-AIDS, which has ravaged sub-Saharan Africa to the extent that grandparents are rearing children with HIV simply because they have no access to antiviral treatment. Hepatitis B is another important issue in this respect. For hundreds of families who were lucky enough to be asylum seekers in this country, a cycle which had lasted 400 or 500 years of mothers passing hepa[830]titis to their children was broken because the children were given antivirals when they were born. This basic and inexpensive treatment is freely available here. The same can be said in respect of vaccinations for illnesses such as measles, which used to cause havoc in this country. When spurious research published in the UK persuaded parents in the Dublin region to refuse MMR vaccine for their children, three children died and a number of others were left with nervous deformities. This is happening every day in parts of the world where children do not have access to vaccines rather than because of silly nonsense and some sort of neoliberal attitude that prefers natural methods to vaccination for children.

We should focus on these matters because they will make a huge difference to people’s lives. The simplest steps that make the greatest difference are vaccination, retaining health care professionals and improving hygiene. Many of the hospitals in these countries lack electricity generators or proper sterilisation equipment. Even though €4.5 million is small change, it will go a long way, and the overall UN budget for all the millennium development goals is in excess of €1 billion. We need to ensure that money is well spent.

Minister of State at the Department of Foreign Affairs (Deputy Michael P. Kitt): Information on Michael Kitt Zoom on Michael Kitt I welcome the opportunity to address the Seanad on the pressing international development issue of maternal health and mortality. I thank Senators for their contributions and I am pleased the motion is agreed.

In 2000, maternal health was selected as one of the eight highest priorities for the future of developing countries. By including the issue in the millennium development goals, heads of state and governments underscored the magnitude of this problem and its tragic implications not only for the women affected but also for their children. I regret to say, however, that the challenge is not being met by the international community. Despite the promises made in MDG No. 5 to reduce the maternal mortality ratio by three quarters by 2015, the mortality rate has remained at the same level as in 1990. The actual number of women dying has increased, from 529,000 in 2000 to 536,000 at present.

This mortality rate varies hugely by geographic region. With 96% of maternal deaths worldwide, sub-Saharan Africa and Asia suffer disproportionately. In some African countries the lifetime risk of death in childbirth for women is as high as one in seven. Within Africa the figure can vary wildly from country to country. Deaths per 100,000 live births are 230 in South Africa, 1,000 in Mozambique and a shocking 1,800 in Malawi according to the most recent figures. There is no sign of this overall picture changing despite pockets of encouraging progress. While progress has been slow in all regions, sub-Saharan Africa shows the least progress in the maternal mortality [831]rate, dropping by only 0.1 % annually compared to the target of 5.5%. This lack of progress has been due to a number of factors. For many years, the largest obstacle to progress in maternal health has been a lack of political will and resources. In the competition for scarce resources in over-stretched health systems, women’s needs have tended to be pushed aside. Emergency obstetric care has been often viewed as a luxury rather than as a basic right. Access to contraception is also a major factor. When women in the developing world cannot choose to control the spacing between births, their ability to return to health between births can be compromised. This increases the chances of complications in pregnancy, bringing greater risks to their health and to that of their child.

The latest maternal mortality figures have evoked a reaction not only among the donor community but also in developing countries. It is now clear there will be no progress on the fifth millennium development goal unless there is a sea change in thinking. This includes major advances in funding from donors and the prioritisation of the issue by developing countries.

The total human cost of these unnecessary deaths is increasingly clear. The cost is not only the loss of these young women and the trauma to their families but also the added vulnerability of the children they leave behind. It has been shown in many UN studies that children who lose their mothers at a young age have an increased risk of dying before the age of five and those who do survive have a lower likelihood of attending school. They also have a greater lifetime risk of extreme poverty. Therefore, these young women are not only important in their own right but are vital to the lifetime prospects of their children. MDG No. 5 on maternal health and MDG No. 4 on child survival are intrinsically linked. Safer childbirth for the mother is also safer for the child, reducing the number of children dying shortly after birth. A link has been also identified between maternal mortality and malaria, HIV and AIDS and a number of other medical conditions. Issues as basic as human resources for health, access to functioning medical equipment, adequate supplies and medical hygiene are all key factors in improving survival rates.

In the past year donors have taken additional steps to address this important issue. A number of European governments, including Ireland, have increased their funding to issues around maternal mortality and attempted to bring to public attention the shocking loss of life being sustained by women in developing countries. In the White Paper on Irish Aid, the Government clearly outlined its commitment to supporting the specific health needs of women. The White Paper states that, “addressing women’s health needs, particularly in the areas of basic healthcare and maternal and reproductive health must lie at the [832]heart of an effective overall response to improving health in developing countries”.

Since the White Paper’s publication, Irish Aid has developed a health policy which addresses issues of maternal mortality, including the determinants of maternal mortality. It strengthens systems, especially those serving the poor, and it contributes to an effective international response to their health needs. Irish Aid does this through bilateral assistance, regional partnerships where appropriate, global partnerships and civil society. In our bilateral programmes we support priority country governments in sub-Saharan Africa to deliver a package of basic health care, including reproductive health care. Additional support is granted for specific initiatives on maternal health, such as the new midwifery school in Northern Province, Zambia, which opened in 2006. Another example is our commitment of €2.3 million in 2006 to a four-year project in Tanzania, Mozambique and Malawi to improve the provision of maternal health services by mid-level health workers. In addition to this funding, Irish Aid works through several partner agencies in the UN system to address maternal health and contraception. Ireland gives significant support to WHO, UNICEF, UNFPA, UNAIDS and UNDP and the Global Fund for Aids, TB and Malaria, all of which contribute to reducing maternal mortality.

One of the main barriers to achieving universal access to reproductive health is the lack of empowerment of women in developing countries. These issues form the core mandate of the United Nations Population Fund, UNFPA, which is one of Ireland’s key partners in the UN system. The importance of its work on gender, reproductive health, maternal mortality and HIV-AIDS is recognised by the 180 governments worldwide that contributed to its funds in 2007. In light of its important mandate, the Government increased core funding to UNFPA in the past five years from €1.8 million in 2003 to €4.5 million in 2007. In addition, in 2007 the Government made a contribution of €1 million to the UNFPA trust fund for global reproductive health commodities security, which aims to ensure that governments have a constant supply of reproductive health products. These include basic supplies for obstetric care and to allow for safer births.

Its particular focus on reproductive health and maternal health made UNFPA the natural home for a new UN trust fund to harness the donor commitment to maternal health. This new campaign — No Woman should Die giving Life — was launched in December 2007. Ireland was among the first countries to donate to the fund, contributing €2 million. Those responsible for the fund will work with governments to increase capacities in three specific areas which have been proven to reduce maternal mortality, namely, family planning, skilled attendance at birth and emergency obstetric care.

[833]The need for family planning is one of the most important factors contributing to the current unacceptable rates of maternal mortality. UNFPA estimates that 200 million women who want to space their children cannot currently do so. This lack of empowerment has a serious adverse impact on their health and increases their risk of dying in childbirth. In countries where the age of marriage is lower, family planning can avert many of the dangers associated with high-risk adolescent pregnancies.

Having skilled attendance at birth has been proven to be the most effective intervention in reducing maternal mortality. In some countries the percentage of women with access to skilled midwives is as low as 5%. Predictably, these are the countries with the highest mortality rates.

The most common cause of death in childbirth is post-partum haemorrhage. A woman can bleed to death in under two hours. For this reason, UNFPA will work with governments to introduce a network of emergency obstetric centres. These will deal with emergencies that are beyond the training of attendants with basic skills.

The fund has divided its work into two periods. For the period 2008-11, it will operate in 25 of the worst affected countries, developing the most effective strategies and adapting them as needs be. In the second period, 2012-15, the fund will extend its work to a further 50 countries in an effort to make the much needed progress before the millennium development goal deadline of 2015. In light of the excellent reports that I hear back from Irish Aid offices in the field and UNFPA’s record in delivering good results for women in developing countries, I am confident that this trust fund will make a very positive impact on maternal health.

Irish Aid is pleased to have also contributed to two other UNFPA trust funds intended to improve the quality of life of mothers. We have contributed €500,000 to the trust fund to support UNFPA’s work in obstetric fistula. This fund was launched in 2001 and has drawn extensive attention to this distressing condition affecting women in developing countries. Obstetric fistula is typically the result of prolonged labour and in most cases the baby does not survive. The humiliation of the condition often leads women to be stigmatised within their communities and abandoned by their husbands. The prevalence of this condition is highest in sub-Saharan Africa. However, the condition is easily preventable, by ensuring skilled attendance at birth. Treatment for those who have suffered from fistula costs only €200.

Ireland is also supporting work on female genital mutilation through a trust fund established by UNFPA and UNICEF. These two organisations are working jointly in 17 countries to encourage the abandonment of this practice, which currently affects between 100 million and 140 million women and girls and 3 million girls are at risk annually. This programme is designed to work with cultural and religious leaders to encourage [834]what Senator de Búrca referred to as a societal change and the abandonment of the practice. Those responsible for its operation have selected 17 countries and are working systematically at government and local level to change attitudes. I announced Ireland’s contribution of €500,000 to the trust fund this month.

We are now more than halfway towards the deadline for the achievement of the millennium development goals. It is unacceptable that maternal health continues to lag behind the rest. This issue remains a priority for Irish Aid. We are proud of the contribution we have made to date but we are acutely conscious much more remains to be done.

I share the concerns of Senators Fitzgerald and O’Malley in respect of adolescent motherhood. UNFPA is doing important work in this area, which we will support. The Senators will be aware that empowerment and access to family planning are key factors in improving the circumstances of adolescent women. This aspect lies at the core of UNFPA’s work and is a priority for Irish Aid in its support for the latter.

I agree with Senator Twomey’s comments regarding audits, oversight and scrutiny in respect of our overseas development programme. We discussed this issue at this morning’s meeting of the Joint Committee on Foreign Affairs. The Senator also referred to value for money. We carry out value for money audits, particularly in respect of HIV-AIDS.

Senators Cummins and Mullen asked if UNFPA is involved in promoting abortion. The policy laid down by the governing council of UNFPA in 1985 states that it is the policy to the fund “not to provide assistance for abortions, abortion services or abortion-related equipment and supplies as a method of family planning”. Through our membership of the UNFPA’s executive board and as a result of our missions in developing countries, we are confident that UNFPA abides by the policy laid down by its governing council. Furthermore, we received a categorical assurance from UNFPA that it does not support any acts relating to abortion.

We will continue to work at country level and with our partners in the global development system to improve conditions for women and to ensure they receive a suitable level of health care. Success is vital, not just for the sake of the women concerned but also for their children and for the societies in which they live.

Senator David Norris: Information on David P.B. Norris Zoom on David P.B. Norris I welcome the opportunity to contribute to the debate, which has been very well informed in nature. I was impressed by the Minister of State’s contribution at this morning’s meeting of the Joint Committee on Foreign Affairs, which was a useful exercise. It will come as no surprise to the Minister of State or other Members to realise that I fully support UNFPA. I had the privilege to visit Thailand where it engaged in a massively effective campaign in [835]respect of HIV-AIDS. The honesty and openness of the instructions given to people on the verge of embarking on sexual life was very impressive.

I have been of the opinion for some times that population issues are the elephant in the room. Since I graduated from Trinity College, the world’s population has doubled and it is now four and a half times larger than it was in 1900. We cannot ignore that fact. I applaud governments such as that in China for trying to face up to this problem. I accept that the Chinese may not have displayed sensitivity in doing so and that there may have been violations of people’s human rights. However, unlike other institutions with political tentacles, they recognise that this is a real problem.

  7 o’clock

I am glad the Minister of State placed on record the truth regarding the position, particularly in the context of the charter of UNFPA. It is important to outline the real situation. UNFPA has always promoted a rights-based approach to family planning — not coercion — and in China this is clear. Those of us who believe in this important issue are delighted that Irish Aid has satisfied itself on numerous occasions that UNFPA is a deserving recipient of taxpayer’s money and that there is no substance whatever to the allegations that have been made. The then Minister of State at the Department of Foreign Affairs, Deputy Conor Lenihan, stated in October 2006 that, “We are proud to remain a strong funder of UNFPA notwithstanding the criticism of that agency, none of which is based on evidence”.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen Not true.

Senator David Norris: Information on David P.B. Norris Zoom on David P.B. Norris The then Minister of State also said:

Frequently, I receive letters from domestic and international groups on this subject stating that we fund all sorts of services, but that is not the case and the UNFPA does not carry out those services.

For example, it does not support or fund the one child policy in China, a main focal point of the criticism we receive.

The UNFPA is a good agency . . .

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen It tried to interfere in Nicaragua.

Senator David Norris: Information on David P.B. Norris Zoom on David P.B. Norris In November last year, just a few months ago, there was also a smear made on the UNFPA that it exaggerated maternal mortality statistics for some extraordinary reason. The position is quite clear that it was speaking about a case of underestimating maternal mortality. There can be very manipulative and selective quotations, which can be angled in a particular way.

[836]For example, the following was being claimed:

The problem with the number [the latest maternal death estimate] is that it cannot be substantiated, this is according to the former head of the UN statistics office, Dr. Joseph Chamie. The primary reason the number is suspect is that most countries in the world do not report accurate information on deaths at all.

The fuller quote, when put in context, implies the contrary. I will put the quote on the record.

Dr. Chamie states the world was underestimating maternal death numbers. A point made in the publication was that the old way of getting abortion death figures greatly underestimates the number of deaths caused by abortion and:

Caution should be exercised when examining maternal mortality ratios and making comparisons across countries. Under-registration of maternal deaths varies by country, as does under-registration of the cause of death. Even in developed countries, such as the United States of America, maternal mortality has been found to be under-registered by as much as 27%.

In view of this it is not a question of exaggerating but a question of being careful with statistics. We should also be aware that there is under-estimation of the matter.

I will give another quotation from these lobbying groups. It states “even where the deaths are derived from a civil registration with complete coverage, maternal deaths may be missed or not correctly identified, thus compromising the reliability of such statistics”. The actual quote, from The World’s Women 2005 in context is:

Reliable estimates of maternal mortality are still difficult to obtain for many countries [which only excerpts UNICEF, UNFPA, and WHO explanations of the 2000 death estimates]. There are often the problems of significant under-reporting and misclassification of maternal deaths. Even where deaths are derived from a civil registration system with complete coverage, maternal deaths may be missed or not correctly identified, thus compromising reliability of such statistics.

The problem is again under-reporting rather than exaggeration. It is very important we know this.

With regard to the United States, my colleague, Senator Rónán Mullen is a man for whom I have a genuine estimation and affection. However, I do not agree with him. He raised the question of the American administration and cited Colin Powell. For a general, Colin Powell is rather gutless on these issues. I remember when there was an attempt to introduce equal rights for people with regard to sexual orientation in the American army and it collapsed under the “Don’t Ask, Don’t Tell” concept. That is the amount of moral fibre that fellow has.

[837]This attack, as a result of the extreme evangelistic Protestant right wing in the United States of America, was carried out in the face of the fact that they had already appropriated the funds. More importantly, the eminently respectable independent assessment team of 2002 found no evidence supporting false claims that UNFPA supported or participated in managing a programme of coercive abortion or involuntary sterilisation. The team recommended the release of funds to UNFPA.

The report states:

During our visits to five of the 32 countries we asked many SFPC [State Family Planning Commission] officials, doctors of the local hospitals under the Ministry of health, county administrative officials and ordinary Chinese in spontaneous/no-notice encounters on the street, in a school or in factories whether they were aware of any recent coercive abortions or involuntary sterilisations. All answered in the negative, although some admitted that prior to the joint SFPC/UNFPA programme there had been such cases.

In other words, UNFPA is operating in China to prevent these coercive policies. That is the truth.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen Oh dear.

Senator David Norris: Information on David P.B. Norris Zoom on David P.B. Norris Does the Senator want to hear more? Other teams, including one from the United Nations, a parliamentary group from the United Kingdom and a multi-faith panel of religious leaders from the United States, came to the same conclusion. The annual human rights report of the United Kingdom indicated, “these allegations are without foundation.”

There is plenty of good news, including in China. Knowledge of HIV and AIDS has risen from 75% to 93% and knowledge of effective prevention methods has remained at 90%. Knowledge of more than three modern contraceptives has risen from 73% to 99% and abortion rates have dropped from 24 per 1,000 women of childbearing age to ten per 1,000. That is a direct result of the policies of the UNFPA.

The same misinformation is given in regard to Peru. I mentioned the Protestant fundamentalist groups in the United States and we should also look at the impact of the Vatican. There is a pathetic case in the Philippines, where 80% of the people are Roman Catholic. The president is a staunch Catholic, as is the mayor of Manila, José Atienza. He produced what was termed a “natural family planning” programme, passing an executive order which upholds family planning but he was very careful not to ban artificial contraception outright.

The impact was that condoms and contraceptive pills, which had been freely available, were removed completely. People could not get them. There was a case here of Mrs. McGee, and people in the Philippines are now going through the [838]same process. People were able to get some access by travelling and the matter is now going to court. I wish these people well as I do not think they should be deprived because of a faith-based view, which is not supported by evidence.

I am glad to have had the opportunity to place in context some of the matters my colleague, Senator Mullen, has discussed with the most honest intentions.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen The Senator did not mention why the UNFPA chose to interfere with Nicaragua.

An Leas-Chathaoirleach: Information on Paddy Burke Zoom on Paddy Burke Senator Norris, without interruption. He should conclude.

Senator David Norris: Information on David P.B. Norris Zoom on David P.B. Norris The Senator was not correct and I have placed his statements in the correct context. I would not be inclined to mention Nicaragua as I might come back and bite the Senator with that one.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen We might bring Daniel Ortega in to testify.

Senator David Norris: Information on David P.B. Norris Zoom on David P.B. Norris I know Daniel Ortega and the job that was done on him too.

Senator Mark Daly: Information on Mark Daly Zoom on Mark Daly I hope Senator Norris does not end up biting Senator Mullen at any stage.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen It could be a love bite.

Senator Mark Daly: Information on Mark Daly Zoom on Mark Daly Even a love bite would not be parliamentary behaviour by both parties. I welcome the contributions of Senators Mullen and Norris, which was enlightening for all of us. We have researched the issue but the speeches and interruptions were enlightening. It is good to have such debate in the House.

I thank Senator Maurice Cummins for coming to an all-party agreement on the motion. I note Senator Alex White’s congratulating the Government and its efforts, although he is not here. I congratulate the Minister on his efforts and that of the Government. I commend the motion to the House.

Senator Rónán Mullen: Information on Ronan Mullen Zoom on Ronan Mullen I do not know if my dissent can be recorded. I do not wish to put the issue to a vote as I support the principle of reducing maternal mortality and other laudable aims. I cannot support UNFPA. I do not know if the dissent can be recorded.

An Leas-Chathaoirleach: Information on Paddy Burke Zoom on Paddy Burke It will be recorded.

Question put and declared carried.

An Leas-Chathaoirleach: Information on Paddy Burke Zoom on Paddy Burke When is it proposed to sit again?

Senator Diarmuid Wilson: Information on Diarmuid Wilson Zoom on Diarmuid Wilson At 10.30 a.m. tomorrow.


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